The Brazilian database on pregnancy in multiple sclerosis

Finkelsztejn, Alessandro; Fragoso, Yára Dadalti; Ferreira, Maria Lúcia Brito; Lana-Peixoto, Marco Aurélio; Alves-Leon, Soniza Vieira; Gomes, Sidney; Damasceno, Benito Pereira; Mendes, Maria Fernanda; Salgado, Pedro Rippel; Correa, Eber Castro; Frota, Elizabeth Regina Comini; Diniz, D.S.; Gama, Paulo Diniz da; Kaimen-Maciel, Damacio Ramón; Morales, Rogerio Rizo; Arruda, Walter Oleschko; Grzesiuk, Anderson Kuntz; Khouri, Jussara Mathias Netto; Lopes, Josiane; Rocha, Cristiane Franklin; Domingues, Renan Barros; Gonçalves, Marcus Vinícius Magno; Lorenti, M.A.; Parolin, Mônica Koncke Fiuza; Siquineli, Fabio; Tosta, Elza Dias; Brooks, Joseph Bruno Bidin; Gallina, Andre S.; Melges, Luiz Domingos Mendes; Ruocco, Heloisa Helena

doi:10.1016/j.clineuro.2010.11.016

Cited by 58 publications

(52 citation statements)

References 11 publications

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“…[3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. [7][8][9][10] However, the durations of birth hospitalization were not examined in these studies. To our knowledge, only 2 studies have examined birth hospitalization in MS 4,11 ; both were from the United States and reported longer hospital stays for mothers with MS 4,11 and their newborns 11 compared with the general population.…”

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confidence: 99%

Birth hospitalization in mothers with multiple sclerosis and their newborns

Zhao

Zhu

et al. 2013

Neurology

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Objective: To compare the duration of birth hospitalization in mothers with multiple sclerosis (MS) and their newborns relative to the general population and to investigate the impact of MS-related clinical factors on the length of birth hospitalization stays.Methods: Data from the British Columbia Perinatal Database Registry and the British Columbia MS database were linked in this retrospective cohort study. The duration of birth hospitalization in mothers with MS and their newborns (n 5 432) were compared with a frequency-matched sample of the general population (n 5 2,975) from 1998 to 2009. Clinical factors investigated included disease duration and disability, as measured by the Expanded Disability Status Scale. A multivariable model (generalized estimating equations) was used to analyze the association between MS and duration of birth hospitalization, adjusting for factors such as maternal age, diabetes, hypertension, and consecutive births to the same mother. Additional analyses included propensity score matching to further balance cohort characteristics.Results: Compared with the general population, the duration of birth hospitalization was not statistically or clinically different for mothers with MS or their newborns (median differences 5 11.5 and 12.1 hours, respectively; adjusted p . 0.4). Lengths of birth hospitalization were not significantly associated with disease duration (adjusted p . 0.7) or level of disability (adjusted p . 0.5). Findings remained virtually unchanged after propensity score matching.Conclusions: Birth hospitalization has been understudied in women with MS. Contrary to existing studies, we found that MS was not associated with a longer birth hospitalization. This study provides assurance to expectant mothers with MS, their families, and health care providers. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS, often manifesting in women of childbearing age. 1 Fatigue and pelvic organ dysfunction are common, 2 which may cause difficult labor and prolonged birth hospitalization. MS has been associated with a greater risk of difficult labor, 3 assisted vaginal delivery, 3 cesarean delivery, 4 as well as impaired fetal growth and prematurity. [3][4][5][6] Although not all agree, more recent studies found no link between MS and adverse perinatal outcomes. 7-10 However, the durations of birth hospitalization were not examined in these studies. To our knowledge, only 2 studies have examined birth hospitalization in MS 4,11 ; both were from the United States and reported longer hospital stays for mothers with MS 4,11 and their newborns 11 compared with the general population. Prolonged stays can have negative consequences, including an increased risk of hospital-acquired infection as well as creating a strain on scarce health care resources. 12 By linking 2 comprehensive population databases, the British Columbia Multiple Sclerosis (BCMS) database and the British Columbia Perinatal Database Registry (BCPDR), we

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confidence: 99%

Birth hospitalization in mothers with multiple sclerosis and their newborns

Zhao

Zhu

et al. 2013

Neurology

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“…On the other hand, some studies have detected a positive correlation between estrogens and EDSS in pregnant women with MS. Disease progression slows down in pregnancy, particularly in the third trimester, paralleled to an increase in estrogens, whereas after the decline of estrogens in the puerperium, there is a 2-3fold increase in relapse rate [6,[15][16][17][18]. It is thought that estrogens may mediate neuroinflammatory signals and protect against neurodegeneration and consequently the therapeutical potential of estrogens on MS may rely on neuroprotective pathways [19][20][21][22].…”

Section: Discussionmentioning

confidence: 95%

Association of sex hormones and glucose metabolism with the severity of multiple sclerosis

Triantafyllou

Thoda

Armeni

et al. 2015

International Journal of Neuroscience

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“…As for GA, no major concerns have been reported in relation to drug exposure during pregnancy [90,101,103,104,[108][109][110][111]. It has to be noted, however, that the data on GA derive mainly from small-sample studies.…”

Section: Pregnancy and Foetal Developmentmentioning

confidence: 85%

“…As for breast-feeding, excretion of IFN and GA in human milk is not well established [78,81,108,112]. The transfer of these compounds should be limited by their molecular weight [71].…”

Section: Delivery and Breast-feedingmentioning

confidence: 98%

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

Amato

Portaccio

2015

CNS Drugs

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In recent decades, pregnancy-related issues in multiple sclerosis (MS) have received growing interest. MS is more frequent in women than in men and typically starts during child-bearing age. An increasing number of disease-modifying drugs (DMDs) for the treatment of MS are becoming available. Gathering information on their influences on pregnancy-related issues is of crucial importance for the counselling of MS patients. As for the immunomodulatory drugs (interferons and glatiramer acetate), accumulating evidence points to the relative safety of pregnancy exposure in terms of maternal and foetal outcomes. In case of higher clinical disease activity before pregnancy, these drugs could be continued until conception. As for the 'newer' drugs (fingolimod, natalizumab, teriflunomide, dimethyl fumarate and alemtuzumab), the information is more limited. Whereas fingolimod and teriflunomide are likely associated with an increased risk of foetal malformations, the effects of natalizumab, dimethyl fumarate and alemtuzumab still need to be ascertained. This article provides a review of the available information on the use of DMDs during pregnancy, with a specific focus on fertility, foetal development, delivery and breast-feeding.

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The Brazilian database on pregnancy in multiple sclerosis

Cited by 58 publications

References 11 publications

Birth hospitalization in mothers with multiple sclerosis and their newborns

Birth hospitalization in mothers with multiple sclerosis and their newborns

Association of sex hormones and glucose metabolism with the severity of multiple sclerosis

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

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